NCLEX Questions, NCLEX Trainer Test 2 Questions, NCLEX-PN Questions, Nurselytic

Questions 157

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Question 1 of 5

A nurse has asked a second staff nurse to sign for a wasted narcotic, which was not witnessed by another person. This seems to be a recent pattern of behavior. What is the appropriate initial action?

Correct Answer: A

Rationale: The incident must be reported to the appropriate supervisor, for both ethical and legal reasons. This is not an incident that a co-worker can resolve without referral to a manager.

Question 2 of 5

The nurse is assigned to care for a client who has a leaking intracranial aneurysm. To minimize the risk of rebleeding, the nurse should plan to

Correct Answer: A

Rationale: restrict visitors to immediate family. Maintaining a quiet environment will assist in minimizing cerebral rebleeding. When family visit, the client should not be disturbed. If the client is awake, topics of a general nature are better choices for discussion than topics that result in emotional or physiological stimulation.

Question 3 of 5

The nurse assesses an 18-month-old child brought to the well child clinic for a routine check-up. Which finding would be of most concern to the nurse?

Correct Answer: C

Rationale: Dropping objects handed to him suggests motor or neurological issues at 18 months, requiring evaluation. Creeping , not being toilet trained , and stranger anxiety are normal.

Question 4 of 5

The nurse is talking with an adult who says she has chronic constipation. What suggestion would probably be most helpful to the client?

Correct Answer: B

Rationale: Fruits and vegetables are high in fiber, promoting bowel regularity and alleviating constipation. Rice is low-fiber, Lomotil slows motility, and limiting fluids to meals can worsen constipation.

Question 5 of 5

The greatest threat during the immediate post-burn period results from burn shock. Which of the following statements best describes why burn shock occurs?

Correct Answer: A

Rationale: Burn shock occurs due to histamine release causing vasodilation and increased capillary permeability, leading to fluid loss from the vascular to interstitial space.

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